Do quality and access to hospital services impact on their technical efficiency?

Investigating the impact of quality and access to healthcare services on technical efficiency is a hot topic in health economics and healthcare systems management. No satisfactory conclusions have been drawn regarding the link between quality and technical efficiency of public hospitals. Furthermore, the impact of access to healthcare facilities on their efficiency has been barely studied. This study uses a robust nonparametric partial frontier method to study the impact of quality and access to healthcare services on their operational efficiency. A set of Portuguese public hospitals (FY2013-FY2016) is considered for this purpose. Findings suggest that good clinical safety practices in hospital services are associated with low technical efficiency levels, thus trade-offs between efficiency and quality are expected in some dimensions. No meaningful link between access and technical efficiency was observed, although highly efficient entities are associated with low childhood mortality ratios.

[1]  A. U.S.,et al.  Measuring the efficiency of decision making units , 2003 .

[2]  B. Hollingsworth The measurement of efficiency and productivity of health care delivery. , 2008, Health economics.

[3]  J. Elfar,et al.  Timing of Hip Fracture Surgery in the Elderly , 2014, Geriatric orthopaedic surgery & rehabilitation.

[4]  Jonathan H. Chen,et al.  Improving and sustaining a reduction in iatrogenic pneumothorax through a multifaceted quality-improvement approach. , 2015, Journal of hospital medicine.

[5]  H. Davies,et al.  Assessing the quality of care , 1995, BMJ.

[6]  Yasar A. Ozcan,et al.  Are hospitals producing quality care efficiently? An analysis using Dynamic Network Data Envelopment Analysis (DEA) , 2017 .

[7]  A. Laporte,et al.  Analysis of productivity, efficiency and technological changes in hospital services in Ontario: how does case-mix matter? , 2014 .

[8]  Vania Sena,et al.  Is there a Trade-Off between Quality and Productivity? The Case of Diagnostic Technologies in Portugal , 2001, Ann. Oper. Res..

[9]  Léopold Simar,et al.  Directional distances and their robust versions: Computational and testing issues , 2013, Eur. J. Oper. Res..

[10]  D. Peters,et al.  Poverty and Access to Health Care in Developing Countries , 2008, Annals of the New York Academy of Sciences.

[11]  Ismael Moya Clemente,et al.  A model to measure the efficiency of hospital performance , 2010, Math. Comput. Model..

[12]  Nurhan Davutyan,et al.  Hospital efficiency with risk adjusted mortality as undesirable output: the Turkish case , 2014, Ann. Oper. Res..

[13]  Vivian Valdmanis,et al.  High versus lower quality hospitals: a comparison of environmental characteristics and technical efficiency , 2010, Health Services and Outcomes Research Methodology.

[14]  Giorgio Vittadini,et al.  The effectiveness-efficiency trade-off in health care: The case of hospitals in Lombardy, Italy. , 2014, Regional science and urban economics.

[15]  Bülent Sezen,et al.  Analyzing the ambiguous relationship between efficiency, quality and patient satisfaction in healthcare services: the case of public hospitals in Turkey. , 2013, Health policy.

[16]  Rowena Jacobs,et al.  Measuring Efficiency in Health Care: Analytic Techniques and Health Policy , 2006 .

[17]  V. Valdmanis,et al.  Hospital quality, efficiency, and input slack differentials. , 2008, Health services research.

[18]  R. Andersen,et al.  A framework for the study of access to medical care. , 1974, Health services research.

[19]  J. Schreyögg,et al.  Effects of Ownership on Hospital Efficiency in Germany , 2009 .

[20]  Emmanuel Thanassoulis,et al.  Negative data in DEA: a directional distance approach applied to bank branches , 2004, J. Oper. Res. Soc..

[21]  M. Grossman On the Concept of Health Capital and the Demand for Health , 1972, Journal of Political Economy.

[22]  Ali Emrouznejad,et al.  Hospital performance: Efficiency or quality? Can we have both with IT? , 2015, Expert Syst. Appl..

[23]  Rui Cunha Marques,et al.  Identifying congestion levels, sources and determinants on intensive care units: the Portuguese case , 2018, Health care management science.

[24]  Léopold Simar,et al.  Probabilistic characterization of directional distances and their robust versions , 2012 .

[25]  Peter Smith,et al.  Data envelopment analysis applied to quality in primary health care , 1996, Ann. Oper. Res..

[26]  D. Helling,et al.  Kaiser Permanente Colorado Region Pharmacy Department: innovative leader in pharmacy practice. , 2006, Journal of the American Pharmacists Association : JAPhA.

[27]  K. Schoelles,et al.  Preventing In-Facility Pressure Ulcers as a Patient Safety Strategy , 2013, Annals of Internal Medicine.

[28]  Ahti Salo,et al.  Developing robust composite measures of healthcare quality - Ranking intervals and dominance relations for Scottish Health Boards. , 2016, Social science & medicine.

[29]  R. Egdell,et al.  Is a target culture in health care always compatible with efficient use of resources? A cost-effectiveness analysis of an intervention to achieve thrombolysis targets. , 2006, Journal of public health.

[30]  Rui Cunha Marques,et al.  Economies of scope in the health sector: The case of Portuguese hospitals , 2018, Eur. J. Oper. Res..

[31]  Daniel G Shimshak,et al.  Incorporating Quality into Data Envelopment Analysis of Nursing Home Performance: A Case Study. , 2009, Omega.

[32]  B. Hollingsworth Non-Parametric and Parametric Applications Measuring Efficiency in Health Care , 2003, Health care management science.

[33]  Stuart Guterman,et al.  Hospital cost of care, quality of care, and readmission rates: penny wise and pound foolish? , 2010, Archives of internal medicine.

[34]  L. Mobley,et al.  The impact of managed care penetration and hospital quality on efficiency in hospital staffing. , 2002, Journal of health care finance.

[35]  James Moises,et al.  Social Efficiency of Hospital Care Delivery: Frontier Analysis From the Consumer’s Perspective , 2011, Medical care research and review : MCRR.

[36]  Wu Zeng,et al.  The trade-offs between efficiency and quality in the hospital production: Some evidence from Shenzhen, China , 2014 .

[37]  J. Zuckerman Hip fracture. , 1996, The New England journal of medicine.

[38]  Yauheniya Varabyova,et al.  Integrating quality into the nonparametric analysis of efficiency: a simulation comparison of popular methods , 2018, Ann. Oper. Res..

[39]  Yasar A. Ozcan,et al.  An examination of competition and efficiency for hospital industry in Turkey , 2015, Health care management science.

[40]  Hsihui Chang,et al.  Hospital ownership and operating efficiency: Evidence from Taiwan , 2004, Eur. J. Oper. Res..

[41]  Yauheniya Varabyova,et al.  Erratum to: Using nonparametric conditional approach to integrate quality into efficiency analysis: empirical evidence from cardiology departments , 2017, Health care management science.

[42]  Gary D. Ferrier,et al.  Incorporating quality into the measurement of hospital efficiency: a double DEA approach , 2013 .

[43]  Wim Groot,et al.  Principal agent relationships and the efficiency of hospitals , 2009, The European Journal of Health Economics.

[44]  Pedro Simões,et al.  Performance and congestion analysis of the portuguese hospital services , 2011, Central Eur. J. Oper. Res..

[45]  Yasar A. Ozcan,et al.  Data Envelopment Analysis Comparison of Hospital Efficiency and Quality , 2008, Journal of Medical Systems.

[46]  Yauheniya Varabyova,et al.  Using nonparametric conditional approach to integrate quality into efficiency analysis: empirical evidence from cardiology departments , 2017, Health care management science.

[47]  J. L. Navarro-Espigares,et al.  Efficiency and quality in health services: a crucial link , 2011 .

[48]  I. Gijbels,et al.  Robustness and inference in nonparametric partial frontier modeling , 2011 .

[49]  Dorte Gyrd-Hansen,et al.  Exploring the relationship between costs and quality: Does the joint evaluation of costs and quality alter the ranking of Danish hospital departments? , 2011, The European Journal of Health Economics.

[50]  Myfanwy Morgan,et al.  What does 'access to health care' mean? , 2002, Journal of health services research & policy.

[51]  Valentin Zelenyuk,et al.  Performance of hospital services in Ontario: DEA with truncated regression approach , 2016 .

[52]  Dominique Deprins,et al.  Measuring Labor-Efficiency in Post Offices , 2006 .

[53]  V. Valdmanis,et al.  Is more better? An analysis of hospital outcomes and efficiency with a DEA model of output congestion , 2008, Health care management science.

[54]  C. Thomas-Agnan,et al.  NONPARAMETRIC FRONTIER ESTIMATION: A CONDITIONAL QUANTILE-BASED APPROACH , 2005, Econometric Theory.

[55]  L. Siciliani,et al.  Choice of hospital: Which type of quality matters? , 2016, Journal of health economics.

[56]  Herve Leleu,et al.  A robust analysis of hospital efficiency and factors affecting variability , 2018, Health services management research.

[57]  Rui Cunha Marques,et al.  Malmquist and Hicks-Moorsteen Productivity Indexes for Clusters Performance Evaluation , 2016, Int. J. Inf. Technol. Decis. Mak..

[58]  Gary D. Ferrier,et al.  Rural hospital performance and its correlates , 1996 .

[59]  Joe Zhu,et al.  Incorporating health outcomes in Pennsylvania hospital efficiency: an additive super-efficiency DEA approach , 2014, Ann. Oper. Res..

[60]  Rui Cunha Marques,et al.  Should inpatients be adjusted by their complexity and severity for efficiency assessment? Evidence from Portugal , 2016, Health care management science.

[61]  Po-Chi Chen,et al.  Efficiency and productivity change in Taiwan’s hospitals: a non-radial quality-adjusted measurement , 2013, Central Eur. J. Oper. Res..

[62]  Jonathan Mant,et al.  Detecting differences in quality of care: the sensitivity of measures of process and outcome in treating acute myocardial infarction , 1995, BMJ.

[63]  Diego Prior,et al.  Efficiency and total quality management in health care organizations: A dynamic frontier approach , 2006, Ann. Oper. Res..

[64]  A. Donabedian Evaluating the quality of medical care. 1966. , 1966, The Milbank quarterly.

[65]  E. Lettieri,et al.  Efficiency and quality of care in nursing homes: an Italian case study , 2011, Health care management science.

[66]  C. Mateus,et al.  Cost effects of hospital mergers in Portugal , 2014, The European Journal of Health Economics.

[67]  F. Millham,et al.  Increased risk of postoperative deep vein thrombosis and pulmonary embolism in patients with inflammatory bowel disease: a study of National Surgical Quality Improvement Program patients. , 2012, Archives of surgery.

[68]  Léopold Simar,et al.  How to measure the impact of environmental factors in a nonparametric production model , 2012, Eur. J. Oper. Res..

[69]  Yasar A. Ozcan,et al.  Health Care Benchmarking and Performance Evaluation: An Assessment Using Data Envelopment Analysis (DEA) , 2007 .

[70]  K. Mulholland,et al.  How access to health care relates to under‐five mortality in sub‐Saharan Africa: systematic review , 2010, Tropical medicine & international health : TM & IH.

[71]  Ole Bent Olesen,et al.  Stochastic Data Envelopment Analysis - A review , 2016, Eur. J. Oper. Res..

[72]  José Rui Figueira,et al.  Patients’ satisfaction: The medical appointments valence in Portuguese public hospitals , 2017, Omega.

[73]  J. Benbassat,et al.  Hospital readmissions as a measure of quality of health care: advantages and limitations. , 2000, Archives of internal medicine.

[74]  Miika Linna,et al.  Measuring the productive efficiency and clinical quality of institutional long-term care for the elderly. , 2005, Health economics.

[75]  Che-Ming Yang,et al.  Feasibility and validity of International Classification of Diseases based case mix indices , 2006, BMC Health Services Research.

[76]  Rui Cunha Marques,et al.  Did the corporatization of Portuguese hospitals significantly change their productivity? , 2015, The European Journal of Health Economics.

[77]  Sónia M. A. Morgado Does health promote economic growth? Portuguese case study: from dictatorship to full democracy , 2014, The European Journal of Health Economics.

[78]  C. Bonetto,et al.  Guidelines for preoperative assessment: impact on clinical practice and costs. , 2005, International journal for quality in health care : journal of the International Society for Quality in Health Care.

[79]  R. Marques,et al.  Integrating Infrastructure and Clinical Management in PPPs for Health Care , 2013 .

[80]  Domenica Matranga,et al.  Congestion analysis to evaluate the efficiency and appropriateness of hospitals in Sicily. , 2015, Health policy.

[81]  Kostas Kounetas,et al.  How efficient are Greek hospitals? A case study using a double bootstrap DEA approach , 2013, The European Journal of Health Economics.

[82]  P. W. Wilson,et al.  Estimation and inference in two-stage, semi-parametric models of production processes , 2007 .

[83]  Pablo Arocena,et al.  Accounting for quality in the measurement of hospital performance: evidence from Costa Rica. , 2007, Health economics.

[84]  F. Schut,et al.  Do patients choose hospitals with high quality ratings? Empirical evidence from the market for angioplasty in the Netherlands. , 2012, Journal of health economics.

[85]  Fang Yu,et al.  Benchmarking urban acute care hospitals: efficiency and quality perspectives. , 2013, Health care management review.

[86]  Donna L. Retzlaff-Roberts,et al.  The Trade-off Between Hospital Cost and Quality of Care: An Exploratory Empirical Analysis , 1992, Medical care.

[87]  A. Charnes,et al.  Some Models for Estimating Technical and Scale Inefficiencies in Data Envelopment Analysis , 1984 .

[88]  Hsihui Chang,et al.  Taiwan quality indicator project and hospital productivity growth , 2010, Omega.

[89]  A. Janke,et al.  Health Literacy and Access to Care , 2016, Journal of health communication.

[90]  J. Florens,et al.  Nonparametric frontier estimation: a robust approach , 2002 .